Physical activity and the risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related mortality in South Korea: a nationwide cohort study - PubMed

. 2021 Jul 22;bjsports-2021-104203. doi: 10.1136/bjsports-2021-104203. Online ahead of print. Seung Won Lee   1 Jinhee Lee   2 Sung Yong Moon   3 Hyun Young Jin   3 Jee Myung Yang   4 Shuji Ogino   5   6 Mingyang Song   5 Sung Hwi Hong   7 Ramy Abou Ghayda   8 Andreas Kronbichler   9 Ai Koyanagi   10   11 Louis Jacob   10   12   13 Elena Dragioti   14 Lee Smith   15 Edward Giovannucci   5   16   17 I-Min Lee   5   18 Dong Hoon Lee   17 Keum Hwa Lee   19 Youn Ho Shin   20 So Young Kim   21 Min Seo Kim   22 Hong-Hee Won   22 Ulf Ekelund   23   24 Jae Il Shin   25 Dong Keon Yon   26

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Seung Won Lee  et al. Br J Sports Med . 2021 .

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. 2021 Jul 22;bjsports-2021-104203. doi: 10.1136/bjsports-2021-104203. Online ahead of print.

Authors

Seung Won Lee   1 Jinhee Lee   2 Sung Yong Moon   3 Hyun Young Jin   3 Jee Myung Yang   4 Shuji Ogino   5   6 Mingyang Song   5 Sung Hwi Hong   7 Ramy Abou Ghayda   8 Andreas Kronbichler   9 Ai Koyanagi   10   11 Louis Jacob   10   12   13 Elena Dragioti   14 Lee Smith   15 Edward Giovannucci   5   16   17 I-Min Lee   5   18 Dong Hoon Lee   17 Keum Hwa Lee   19 Youn Ho Shin   20 So Young Kim   21 Min Seo Kim   22 Hong-Hee Won   22 Ulf Ekelund   23   24 Jae Il Shin   25 Dong Keon Yon   26

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Abstract

Purpose: To determine the potential associations between physical activity and risk of SARS-CoV-2 infection, severe illness from COVID-19 and COVID-19 related death using a nationwide cohort from South Korea.

Methods: Data regarding 212 768 Korean adults (age ≥20 years), who tested for SARS-CoV-2, from 1 January 2020 to 30 May 2020, were obtained from the National Health Insurance Service of South Korea and further linked with the national general health examination from 1 January 2018 to 31 December 2019 to assess physical activity levels. SARS-CoV-2 positivity, severe COVID-19 illness and COVID-19 related death were the main outcomes. The observation period was between 1 January 2020 and 31 July 2020.

Results: Out of 76 395 participants who completed the general health examination and were tested for SARS-CoV-2, 2295 (3.0%) were positive for SARS-CoV-2, 446 (0.58%) had severe illness from COVID-19 and 45 (0.059%) died from COVID-19. Adults who engaged in both aerobic and muscle strengthening activities according to the 2018 physical activity guidelines had a lower risk of SARS-CoV-2 infection (2.6% vs 3.1%; adjusted relative risk (aRR), 0.85; 95% CI 0.72 to 0.96), severe COVID-19 illness (0.35% vs 0.66%; aRR 0.42; 95% CI 0.19 to 0.91) and COVID-19 related death (0.02% vs 0.08%; aRR 0.24; 95% CI 0.05 to 0.99) than those who engaged in insufficient aerobic and muscle strengthening activities. Furthermore, the recommended range of metabolic equivalent task (MET; 500-1000 MET min/week) was associated with the maximum beneficial effect size for reduced risk of SARS-CoV-2 infection (aRR 0.78; 95% CI 0.66 to 0.92), severe COVID-19 illness (aRR 0.62; 95% CI 0.43 to 0.90) and COVID-19 related death (aRR 0.17; 95% CI 0.07 to 0.98). Similar patterns of association were observed in different sensitivity analyses.

Conclusion: Adults who engaged in the recommended levels of physical activity were associated with a decreased likelihood of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death. Our findings suggest that engaging in physical activity has substantial public health value and demonstrates potential benefits to combat COVID-19.

Keywords: COVID-19; physical activity.

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1

Participant profile in all cohort.

Figure 1

Participant profile in all cohort.

Figure 1

Participant profile in all cohort.

Figure 2

Directed acyclic graph demonstrating the…

Figure 2

Directed acyclic graph demonstrating the implicitly assumed causal association between physical activity (‘exposure’)…

Figure 2

Directed acyclic graph demonstrating the implicitly assumed causal association between physical activity (‘exposure’) and risk of COVID-19 (‘outcome’) in the Korean nationwide cohort before matching. Confounders, potential mediators and exposure–outcome associations are indicated. BMI, body mass index; BP, blood pressure; CCI, Charlson comorbidity index; CVD, cardiovascular disease; GFR, glomerular filtration rate; TB, tuberculosis.

Figure 3

Association between physical activity according…

Figure 3

Association between physical activity according to 2018 physical activity guidelines for Americans and…

Figure 3

Association between physical activity according to 2018 physical activity guidelines for Americans and SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death in cohort A. (A) Association between physical activity according to MET score and SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death in cohort C (B) and cohort D (C). The level of physical activity was categorised into four: (1) inactive (0 MET min/week), (2) insufficiently active (0–

References

    1. Lee SW, Yang JM, Yoo IK, et al. . Proton pump inhibitors and the risk of severe COVID-19: a post-hoc analysis from the Korean nationwide cohort. Gut 2020. doi:10.1136/gutjnl-2020-323672. [Epub ahead of print: 10 Dec 2020]. - DOI - PubMed
    1. Lee SW, Yang JM, Moon SY, et al. . Association between mental illness and COVID-19 susceptibility and clinical outcomes in South Korea: a nationwide cohort study. Lancet Psychiatry 2020;7:1025–31.10.1016/S2215-0366(20)30421-1 - DOI - PMC - PubMed
    1. Lee SW, Ha EK, Yeniova Abdullah Özgür, et al. . Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching. Gut 2021;70:76–84.10.1136/gutjnl-2020-322248 - DOI - PubMed
    1. Haas EJ, Angulo FJ, McLaughlin JM, et al. . Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data. Lancet 2021;397:1819–29.10.1016/S0140-6736(21)00947-8 - DOI - PMC - PubMed
    1. Yang JM, Koh HY, Moon SY, et al. . Allergic disorders and susceptibility to and severity of COVID-19: A nationwide cohort study. J Allergy Clin Immunol 2020;146:790–8.10.1016/j.jaci.2020.08.008 - DOI - PMC - PubMed
https://pubmed.ncbi.nlm.nih.gov/34301715/